Refugees face diabetes risk in poor new land

When refugees end up in poor neighbourhoods in a new land, they may also end up with increased risk of type 2 diabetes, a Swedish study suggests.

Researchers analysed data for more than 61,000 refugees who arrived in Sweden from 1987 to 1991 to see how many of them developed diabetes roughly two decades after settling into their new communities.

"Our study takes advantage of a natural experiment the Swedish government unwittingly created when it dispersed refugees across the country, more or less at random, to ease labour market conditions and help new arrivals integrate more easily into Swedish society," said lead study author Justin White, a health economics researcher at the University of California, San Francisco.
 

"After two decades, refugees who had been assigned to the most deprived neighbourhoods were 15 per cent more likely to develop Type 2 diabetes than those in the least deprived neighbourhoods," White added.

Globally, about one in nine adults have diabetes, and the disease will be the seventh leading cause of death by 2030, according to the World Health Organization.

Most of these people have what's known as Type 2 diabetes, which happens when the body can't properly use or make enough of the hormone insulin to convert blood sugar into energy. Advanced age, obesity and stress are among the factors that can lead to this type of diabetes.

To see how different settlement communities influenced the odds of diabetes among refugees, White and colleagues used data on poverty, unemployment, schooling and welfare enrollment to sort neighbourhoods into three groups based on overall deprivation levels.

Then, they looked at how many refugees were diagnosed with new cases of diabetes from 2002 to 2010 and mapped these cases to the level of deprivation in the communities where people lived.

Refugees included in the study were from 25 to 50 years old and most were married with children. Half of them came from Iran or Arabic-speaking parts of the Middle East and northern Africa, while 10 per cent came from other parts of Africa, 19 per cent from Eastern Europe and 14 percent arrived from Latin America.

Most refugees settled in larger cities, with 47 per cent in high-deprivation areas and another 45 per cent in moderate-deprivation communities.

Overall, about 4,500 of them developed diabetes, or 7.4 per cent of the study population. But when researchers sorted diabetes cases based on the neighbourhood characteristics, they found 7.9 per cent developed diabetes in the highest deprivation areas, compared with just 5.8 percent in the least deprived communities.

One limitation of the study is that even though researchers focused on a period in Swedish history when most refugees were randomly assigned to housing, they can't be certain all refugees in the study were in fact subject to this policy. It's possible some refugees selected their own housing, and the factors influencing this might also impact their odds of developing diabetes.

The study can't prove that bad neighbourhoods cause diabetes or show which specific types of deprivation - like poverty or bad schools - might be most responsible for the added disease risk.

"It could be related to a variety of effects - such as poorer access to healthy food, less opportunity for physical activity, perhaps greater psychological stress which of itself might increase diabetes risk," said Nigel Unwin, a professor at the Chronic Disease Research Center at the University of the West Indies and author of an accompanying editorial.

Still, the findings highlight a need to consider the health impacts of neighbourhoods when assigning refugees to housing as Europe grapples with high unemployment and historically high numbers of incoming refugees, the authors conclude.

"It's well known that people living in poorer neighbourhoods in high income countries, such as in North America or Western Europe, tend to have higher rates of chronic health problems including obesity, type 2 diabetes, and greater risk of stroke and heart attack," Unwin added by email.

"It could simply be that the people who are unable to afford to live in more affluent neighbourhoods are at greater risk of these conditions, perhaps related to poorer education and a greater prevalence of unhealthy behaviors," Unwin added.